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Answering the Health ICT Challenge: An Optimized Infrastructure

As the guardian of health data, ICT departments need to deliver technology foundations on which better, more efficient care and services are extended to individuals, who are also empowered to manage their own and their loved ones’ health.

White Paper

Learn from the examples of other health ICT organizations, including how to:

• Deliver a foundation that is based on best practices and connects people and systems for improved collaboration, new health delivery models, and informed decision-making.

• Design and manage an agile infrastructure that incorporates public, private, and hybrid cloud platforms in which health information is easily and securely updated, accessed, stored, retrieved, and exchanged.

• Enable healthcare providers and public health and social services agencies to turn data into information insights, so they can deliver higher quality care to more patients and citizens at a lower cost.

• Empower patients and citizens to proactively manage their own health.

Learn more

ANSWERING THE HEALTH ICT CHALLENGE: AN OPTIMIZED INFRASTRUCTURE / NOVEMBER 2010 2

The information contained in this document represents the current view of Microsoft Corporation on the issues discussed as of the date of publication. Because Microsoft must respond to changing market con-ditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information presented after the date of publication.This White Paper is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS DOCUMENT.

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ContentsExecutive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

In Search of a Holistic View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Answering the Call . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Facing the ICT Challenge in Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

A Strong Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Connected Health Platform Key Offerings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Accelerating the Effort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

The Benefits of an Integrated, Optimized Infrastructure . . . . . . . . . . . . . . . . . . . . . . . 14

For More Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15


Executive Summary • The number one challenge facing healthcare providers and public health and social services

agencies is delivering higher quality care to more patients and citizens at a lower cost.

• A major obstacle is that the diverse players in the health ecosystem traditionally run their own applications in silos, with no interconnection among these applications. The result: no integrated view of how patient care and citizen health information is delivered across the health ecosystem.

• Information and communications technology (ICT) can lead the industry toward an interconnected health platform by delivering an optimized technology infrastructure that com-bines traditional, cloud-based, and hybrid computing models. This infrastructure will pull together the disparate parts of the health ecosystem, thereby enabling better care, work-force mobility, and security-enhanced data-delivery models.

• The new technology infrastructure will also enable patients and citizens to securely access information to proactively manage their own health.

• An optimized infrastructure will provide ICT with a cost-effective way to manage systems and ensure security, compliance, and reliability. This goal is achievable using a common management and development platform that provides common identity and incorporates familiar tools and existing technologies; works across virtually all cloud and non-cloud loca-tions; and incorporates capabilities that are specific to health organizations’ concerns.

• Through common identity and tools that work across public cloud, private cloud, and hy-brid platforms, health organizations have more options than ever for providing data access to patients and care providers while still protecting personal health data.

• The Microsoft Connected Health Framework (CHF) aims to support the full continuum of care to meet the needs of patients and citizens, health professionals, and organizations. Based on the extensible and agile principles of the CHF, the Microsoft Connected Health Platform (CHP) provides offerings for optimizing health ICT infrastructures, including tools, solution accelerators, and prescriptive architecture, design, and implementation guidance.

• Organizations working toward an optimized infrastructure include Dartmouth-Hitchcock Medical Center and the Tennessee Department of Human Services in the United States; Saiseikai Kumamoto Hospital in Japan; Fred IT Group and the Tasmanian Department of Health and Human Services in Australia; the Hospital District of Helsinki and Uusimaa in Finland; annatommie in The Netherlands; and the South East Coast Ambulance Trust in the United Kingdom.


In Search of a Holistic ViewData is now viewed as one of the health ecosystem’s greatest assets—and challenges. The data coursing through the systems and processes of providers, public health and social services agencies, payers, and research facilities involved with healthcare and services is as complex and diverse as the human body itself. It encompasses everything from diagnostic results and dosages to government policies, social services records, health coverage—phar-macological interactions, and more.

Complicating the situation for information and communications technology (ICT) profes-sionals is the vast number of entities involved. Hospitals and clinics, public health and social services agencies, insurance companies, physicians’ offices, patients and citizens, and more, all generate data. Each of these entities usually manages its own applications, its own policies and procedures, and its own billing and payment systems—as appropriate—with limited interconnection among them.

In short, healthcare providers and public health and social services agencies are drowning in data. Unless that data is turned into information, it promises to sink rather than support their efforts to provide quality healthcare and services. By delivering the foundation to combine, manage, analyze, and present data, ICT can help healthcare providers and public health and social services agencies turn data into information and insights. Thanks to cloud technologies, in addition to tools that work across traditional and cloud platforms, this is even more possible today than it was a short time ago.

Meanwhile, it is also clear that patients and citizens and society as a whole can benefit from easily accessed, high-quality health information, be it diagnoses and treatment options or disease management and financial information (see

Figure 1, “Citizen Involvement Is Key,” at left). This result is currently difficult to achieve because systems are saddled with a lack of data insight, excess cost, and—frequently—ineffective delivery of care and services.

“The healthcare industry needs to focus on the core processes that span the payers, the providers, the pharmaceutical companies, and the federal organizations,” says Dan Garrett, a Partner in PricewaterhouseCoopers’ Healthcare IT Practice. “It has to create a consistent view of the patient, of the healthcare delivery process, and how these processes flow between patient, physician, and administrator.” By doing so, healthcare providers, public health and social services agencies, and patients and citizens will view health information—in addition to the care and services provided and received—holistically, rather than in fragmented pieces. Combined with the capability to measure, monitor, and manage this information, organiza-tions will be able to provide more efficient and higher quality care and services.

Clearly, Garrett argues, the industry must start taking a different tack to solve this problem. “No one in the industry is comfortable with how long it’s taking to create solutions for better medical care.”

Citizen Involvement Is KeyWhen patients and citizens and their caregivers have access to health data, programs that help individuals take greater control of chronic conditions bring tangible results.

Fewer Hospital Days 50%

Fewer Inpatient Days 39%

Lower Inpatient Costs 43%

Source: Urban Institute Figure 1


Answering the CallThe answer for forward-looking health ICT organizations is to deliver an optimized infrastructure that—based on best practices and collective learn-ing—enables organizations to more quickly, easily, and cost-effectively con-nect people and systems for improved collaboration and informed decision-making. In the United States, the Tennessee Department of Human Services (DHS) is one organization doing just that.

DHS needed to deliver high-impact applications to improve citizen ser-vices for the tens of thousands of state residents in need, in addition to facilitating information sharing within and among the state’s many agen-cies. Its computing platform at the time presented long development times and high training costs. The organization needed an efficient, secure, and scalable platform for delivering and supporting new solutions. It turned to Microsoft® Visual Studio® Team System 2008 to accelerate development and support its application lifecycle management strategy and to Microsoft® Windows Server® 2008 and Microsoft® SQL Server® 2008 to deliver and sup-port those solutions.

Now, DHS uses in-house expertise to build core services based on a service-oriented architecture (SOA) that are, in turn, based on the Microsoft® .NET framework to support the internal applications used by DHS employees and the online solutions for patients and citizens. “This means a single new piece of software can now help automate internal processes and extend those same services to taxpayers over the Web,” says Tracy White, IS Director at the Tennessee DHS, which leads to cost savings. Using the .NET framework will lead to at least a 25 percent improvement in time-to-market and associ-ated development costs, she says.

Facing the ICT Challenge in Health Organizations inevitably face many challenges on the way to delivering an infrastructure that enables the optimal use of data (see Figure 2, “Barriers to Using Data,” at left). These chal-lenges can be attributed to the triad that underlies all technological delivery: process, people, and technology.

The triad of process, people, and technology includes many obstacles. The following are among them:

Infrastructure. From a process perspective, the main challenge is technical infrastructure. The locations from which health data originates and must be tracked are extensive, as are the auditing requirements. And the information relating to patient or client visits needs to be ac-cessed from even more locations—pharmacies, insurance companies, social services agencies, home health providers, laboratories, patients’ bedsides, and even citizens’ homes.

Barriers to Using Data Health ecosystem officials cite many reasons for why they do not use secondary data. (Secondary use of data is defined as clinical, financial, administrative, and self-reported data that is aggregated, analyzed, and pre-sented in a concise, actionable format for the purposes of identifying trends, predicting outcomes, and influencing patient care, drug development, and therapy choices.)Percentage of Respondents

Base: 700 participants comprising 110+ pharmaceutical and life sciences companies, 130+ payers, and 480+ providers

Source: PricewaterhouseCoopers Survey Figure 2

Do not have electronic health records

Systems not capable of aggregating/insufficient tools to analyze

Concerned about having sufficient data

Concerned about security

Concerned about privacy

Legal barriers

Public relations concerns

57%

46%

47%

22%

17%

37%

52%

24%

21%

22%

27%

22%

22%

32%

17%

13%

12%

11%

13%

10%

7%

Pharmaceutical

Payer

Provider


Additionally, the creation of disease management information and integrated care records, which are key to empowering citizens to make better health and wellness decisions, requires figuring out how to accommodate data from myriad databases, in a variety of formats, and exchanged through different communications mechanisms (via FTP, fax, or across the Web).

One option to consider for simplifying the challenge of exchanging data is cloud-based computing models. Through cloud services (whether private, public, or hybrid), health organizations can more easily allow remote data access to a wide variety of users. For instance, remote clinicians can ac-cess test results and patients can check their medical records, update their personal information, or research health and wellness tools. Cloud-based solutions can also provide faster and less expensive delivery of application development, data and image storage and sharing, PC management and security, and optimized infrastructure.

Service Levels. The people part of the triad equates to meeting service levels; that is, ensuring staff at all points along the care continuum is as efficient and productive as possible. This goal encompasses both granular

issues, such as using advanced technology to avoid dosage errors and drug interactions, and issues on a grander scale, such as ensuring data is aggregated in a way that presents com-plete information for care professionals and patients and citizens.

Underlying service levels is the ubiquitous challenge of keeping budgets in line. Even though recent reports show health as one of the few industries in which budgets and staffing are increasing (see Figure 3, “ICT Operational Budgets Are Increasing,” at left), ICT professionals must still justify these resource requests, which are regularly scrutinized by either govern-ment agencies or non-profit boards.

Data Security. From a technology standpoint, health ICT professionals must contend with increasing security, regulatory, and privacy issues. They need to protect patient and citizen care data from inappropriate access and, at the same time, make it easily accessible to patients and citizens, caseworkers, caregivers, and government agencies. The latter requires data access both to track potential epidemics and disease outbreaks and to promote healthy behavior. For every regulation there is an associated audit record that must be maintained to confirm compliance.

Additionally, hospitals must consider the issue of identity management; that is, ensuring the person accessing the health information is authorized to do so, and whether they really are who they purport to be. With governments enacting an increasing number of provisions regarding electronic health data exchange and storage—in addition to more countries con-sidering data breach notification rules and penalties—the ability to ensure authorization and authentication continues to be crucial.

Accommodating Existing Systems and New Standards. One way to improve the interoper-ability of physical, regulatory, and financial components is to create an infrastructure that enables systems to efficiently work together and to exchange and aggregate data, no matter where the data originates or how it is stored.

ICT Operational Budgets Are IncreasingA handful of industries in the United States are seeing an increase in 2009/2010 IT operational budgets com-pared with last year’s budgets; health is among them. Percent Budget Increase

Base: 200 IT executives Source: Computer Economics

Figure 3

Banking and finance 4.9%

Health providers 4.7%

Professional and technical service firms 4.0%

Utilities and energy 1.3%


This capability entails using systems, platforms, and services that not only manage current healthcare information needs but are also flexible enough to pull in future data. Such a plat-form would enable all types of applications—traditional, open source, and mixed source—

and data in multiple formats to interoperate and coexist.

The health and technology industries are also making significant strides in developing standards as part of U.S. and international health IT initiatives. Here are just three examples of the many positive developments:

• The Integrating the Healthcare Enterprise (IHE) initiative. This standards ef-fort put forth by more than 250 health and technology organizations aims to improve the way computer systems in health share information.

• The Health Level Seven (HL7) standards. These specifications are designed for the exchange and integration of electronic health information in clinical practices and the delivery of health services.

• The Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT). This international health terminology enables clinicians, researchers, and patients and citizens to share and exchange health and clinical terminology worldwide.

Additionally, the XML protocol, industry-standard middleware, and SOA enable the simplified exchange of information among diverse systems. These technologies enable the integration of data from disparate systems. They also increase the availability of information through Web portals and application platforms, which are intended to provide patients and citizens with access to Web-based applications and services to manage their health and wellness needs (see Figure 4, “Optimized ICT Infrastructure Leads to Improved Information Access” at left). These efforts are part of a trend to engage ICT in delivering a citizen-centric approach to healthcare.

In addition to interoperability, new advances in infrastructure and industry-standard middleware technology enable ICT to accommodate—rather than replace—existing systems and to provide a foundation for future develop-ment. A properly delivered integrated infrastructure creates the foundation for solving today’s challenges and tomorrow’s challenges, too.

A Strong FoundationAs part of its strong, ongoing partnership with the health industry, Microsoft has developed the Connected Health Framework (CHF) and the Connected Health Platform (CHP) to provide the building blocks for these key capa-bilities. They allow the flexibility to let health organizations deliver ICT as a service, even if those organizations are providing the infrastructure in their

data centers. If they choose to leverage public cloud resources, such as the Microsoft Online Services, organizations benefit from improved agility along with both economies of scale and economies of skill, thereby enabling them to shift resources to focus on the core activities

Denmark

Finland

Sweden

United Kingdom

U.S. National Institutes of Health

Sundhed.dk

TerveSuomi (HealthFinland)

1177.se

NHS Direct, NHS Choices

PubMed and Medline Plus

Provides access to various services, such as viewing an individual’s hospital re-cords, booking appointments, sending email to healthcare providers, ordering medication, renewing prescriptions, and registering for organ donation. Each patient in Denmark has a custom Web page with information relevant to medical history.

Finland’s portal is being developed to provide citizens with online access to timely and relevant healthcare informa-tion. In the future, it is intended to offer access to electronic health records or online health services. It is currently designed to use semantic Web technol-ogy to solve problems associated with publishing health information online, such as difficulty finding the right information, duplication of effort, and a lack of quality control. All content is designed to be shared and reused by any third-party Web site or application. Finland is developing common meta-data standards and ontologies so data can be easily aggregated from multiple publishers.

Launched in 1998, the portal reflects Sweden’s early start in developing health IT applications designed to improve the patient experience. The portal is intended to provide a government-sponsored outlet for trusted health information. While it does not link to patients’ electronic health records and is not as content-rich as other portals, it had over a million visitors per month in 2008. The Swedish government plans to introduce additional online services, such as scheduling medical appointments and renewing prescriptions.

Is designed to point people to the most appropriate form of treatment and encourage the best use of health services. Provides in-depth information on medical conditions, treatment options, and drug information, in addi-tion to extensive resources for finding healthcare providers.

A database of biomedical research and an online resource for health and drug information.

Country Government- Capabilities Sponsored Portal

Optimized ICT Infrastructure Leads to Improved Information AccessThrough online application platforms, made pos-sible by optimized ICT, governments are working to improve public health.

Source: The Information Technology & Innovation Foundation, “Explaining International IT Application Leadership: Health IT”

Figure 4


for taking care of patients’ and citizens’ health. An additional benefit of using these cloud resources is the capability to shift some of the organizations’ computing budget from capital expenses to operating expenses.

Together, the CHF and the CHP are designed to guide and aid the industry as it moves toward optimized infrastructures that will ultimately improve care and reduce costs.

The Microsoft CHP is the implementation of the CHF Architecture and De-sign Blueprint on the Microsoft platform. The CHF provides a collection of vendor-agnostic best practices and guidelines for delivering service-based and standards-based, interoperable e-health solutions that are integrated, highly secure, flexible, and scalable. Its goal: to improve the industry’s abil-ity to support the full continuum of care and services to meet the needs of patients and citizens, health professionals, and organizations.

For example, Saiseikai Kumamoto Hospital, a comprehensive medical facil-ity for the Hokuriku region in Japan, has implemented the CHF so that its

ICT staff can better integrate clinical and administrative data from across the organization while keeping acquisition and maintenance costs reasonable. It will also be using the CHF to improve business intelligence, encourage detailed information sharing, and support industry standards for improved integration.

Based on the extensible and agile principles of the CHF, Microsoft CHP provides offerings for optimizing health ICT infrastructures, including tools, solution accelerators, and prescriptive architecture, design, and delivery guidance. It provides the foundation for the development, delivery, and operation of open, secure, and extensible e-health solutions on the Microsoft platform. The CHP is designed to provide health organizations with benefits and efficiencies in multiple areas:• Driving value by enabling better alignment between ICT and the health organization’s

strategy• Enhancing security, privacy, and compliance efforts• Improving system adaptability to constantly changing care providers’ needs• Reducing cost• Accommodating options for multiple cloud computing models

Taking advantage of infrastructure optimization (IO) models and tools that Microsoft has de-veloped for other industries, the CHP specializes them for the health industry. These models and tools include Application Platform Optimization (APO) for Health, Business Productivity Infrastructure Optimization (BPIO) for Health, and Core IO for Health (see Figure 5, “Connect-ed Health Platform,” at left). For example, to help address health organizations’ information management challenges, the CHP provides the foundation for capabilities such as enterprise content management (ECM), enterprise search, communication and collaboration tools, and business intelligence (BI). In other words, the CHP is designed to provide the optimal tech-nology foundation for e-health solutions that help address health organizations’ most press-ing challenges and enable better, more efficient care.

Connected Health Platform The CHP takes advantage of IO models and tools that Microsoft has developed for other industries and customizes them for the health industry.

Source: Microsoft Figure 5

Basic to Standardized

Connected Health Framework Architecture and Design Blueprint

Application Platform for Health

Business Productivity Infrastructure for Health

Core Infrastructure for Health

Standardized to Rationalized

Rationalized to Dynamic

Infra

stru

ctur

e &

Pla

tform

Offe

rings


The CHP can also help health organizations determine the best strategy to incorporate cloud computing into their ICT environment. In many cases, cloud-computing options offer economic advantages because they fall under the operating expense budget rather than the capital expense budget. This gives small and midsize health organizations, especially, the flexibility they may need in terms of budgeting for new applications and computing resources. Cloud computing also provides health organizations with the ability to quickly provision computing capability or capac-ity as needs change or test new applications quickly and easily.

Determining which cloud computing models are best for any given situation involves a variety of decisions, such as whether to consolidate servers using virtualization technology or whether to de-liver new applications, such as email or electronic medical records or case management, in a cloud-based scenario.

Indeed, in some situations, health organizations may want to deploy some applications internally, either in a community (a.k.a., private) cloud or in a traditional data center, for security or regula-tory reasons. Other applications may be more appropriate for delivery through a public cloud solution. Organizations can also devise an infra-structure that accommodates both, known as a hybrid cloud solution. Microsoft can help health organizations determine which scenario is most appropriate based on organizational, regulatory, and infrastructure needs.

The IO for Health models and tools helps char-acterize levels of ICT efficiency that organiza-tions can achieve by delivering infrastructure and platform services more efficiently. The underlying goal for all of the IO initiatives is to enable the health ICT department to become a strategic asset to the organization, with an agile infrastructure in which information is easily and securely updated, accessed, stored, retrieved, and exchanged. This goal can be achieved through

the adoption of ICT infrastructure best practices that are available through the CHP with the IO for Health models and tools. These best practices enable organizations to achieve higher optimization status and to benefit from both the increased efficiency of its ICT department and—in general—the lower costs of services delivered by ICT.

Offering

Windows Optimized Client Devices

Optimized Server and Data Center

Security and Compliance

Health Integration and Interoper-ability

Provides

Enables application and information access from anywhere for health professionals, caseworkers, admin-istrators, and patients and citizens. Provides ICT with simplified ap-plication management and better security and control.

Enables a reliable, scal-able, cost-efficient, and secure infrastructure that provides stream-lined management capabilities and secure services that align with organizational and patient and citizen access needs.

In-depth defense ensures secure, identity-based access to data from virtually anywhere, in addition to built-in, integrated security features and simplified security and compliance manage-ment.

Enables ICT to connect data, systems, and processes to help reduce complexity and operational costs and to facilitate connected care.

Sampling of Corresponding CHP Guidance, Tools, and Solution Accelerators

Desktop Automated Build and Deployment http://www.microsoft.com/indus-try/healthcare/technology/hpo/desktop/desktop.aspx

Group Policy for Healthcare Desk-top Management http://www.microsoft.com/indus-try/healthcare/technology/hpo/desktop/grouppolicy.aspx

Microsoft Deployment Toolkit Solutions Pack http://www.microsoft.com/indus-try/healthcare/technology/hpo/desktop/mdt.aspx

Windows Server Update Services Design and Operation http://www.microsoft.com/indus-try/healthcare/technology/hpo/security/wsus.aspx

Test Lab Infrastructure Virtualization http://www.microsoft.com/indus-try/healthcare/technology/hpo/serverbuild/testlab.aspx

Windows SharePoint Services 3.0 Deployment http://www.microsoft.com/indus-try/healthcare/technology/hpo/serverbuild/wssdeployment.aspx

Active Directory Design and Migration http://www.microsoft.com/indus-try/healthcare/technology/hpo/security/activedirectory.aspx

Forefront Client Security Deploy-ment and Operations http://www.microsoft.com/indus-try/healthcare/technology/hpo/security/FCS.aspx

IT Compliance Management Guide http://technet.microsoft.com/en-us/library/dd206732.aspx

The Microsoft Connected Health Framework http://www.microsoft.com/indus-try/healthcare/technology/Health-framework.mspx

XDS.b Developer white paper http://download.microsoft.com/download/1/9/4/19404de3-cce6-4d4a-bfa5-8302ce4bb811/IHE%20XDS%20b%20Developer%20White-paper%205-2008.pdf

Getting Started with HL7 v3 and BizTalk Server 2006http://www.microsoft.com/downloads/details.aspx?FamilyID=ce84af68-35fc-4ded-b9f8-91feff05d8d0&DisplayLang=en

Key Microsoft Products

• Microsoft® Windows® 7 Enterprise

• Microsoft® Windows Server® 2008

• Microsoft® System Center• Microsoft® Windows Mobile®

• Microsoft® Forefront™• Microsoft® Desktop Optimi-

zation Pack

• Microsoft® Windows® 7 Enterprise

• Microsoft® Windows Server®2008

• Microsoft® SQL Server® 2008• Microsoft® System Center• Microsoft® Forefront™

• Microsoft® Active Directory®

• Microsoft® Identity Lifecycle Manager 2007

• Microsoft® Forefront™• Microsoft® Windows

Server®2008

• Microsoft® BizTalk®

• Microsoft® Amalga™ Unified Intelligent System

• Microsoft® Azure Systems Platform

• Microsoft® HealthVault™

A Foundation of Interrelated Parts An integrated infrastructure is enabled by the following components.

Figure 6Source: Microsoft


Connected Health Platform Key OfferingsThe CHP encompasses a number of key offerings, in addition to guidance, tools, and solution accelerators. Individually, they constitute building blocks that contribute to an efficient ICT infrastructure. Collectively, these offerings create a system in which information is easily ac-cessible and exchanged, one that is secure and highly available (see Figure 6, “A Foundation of Interrelated Parts,” on page 10).

Many Microsoft customers have already delivered some of these capabilities in their efforts to work toward an optimized infrastructure, as the following examples show.

Optimized Desktops and Devices. Given the wide variety of people who access health data, ICT staff must ensure that clinicians, patients and citizens, caseworkers, and others have ef-ficient and controlled access to the information they need, no matter what their location is or which device they are using. Offering this flexibility requires that ICT staff use centralized management and security policies. They also need a single, integrated view of client devices across environments. This approach simplifies application and resource management when it comes to delivery, configuration, monitoring, and reporting.

These capabilities can be found at the South East Coast Ambulance Trust. Part of the Na-tional Health Service (NHS) in the United Kingdom, the trust responds to 9-9-9 calls from the public and urgent calls from health professionals in both Kent and Sussex, in addition to providing non-emergency patient transport services (prebooked patient journeys to and from healthcare facilities). The trust’s philosophy is to allow its 3,000-member staff in 65 loca-tions—even remote workers—to efficiently access anything from anywhere, with the appro-priate security permissions.

By migrating three legacy ICT systems into a single state-of-the-art network, the trust has done just that. Its infrastructure is built with Microsoft® Windows® 7, Windows Server 2008, Microsoft® Exchange 2007, SQL Server 2008, Microsoft® Office 2007, and Microsoft® Office Communications Server 2007 R2. Using the security and productivity features of Windows 7, remote staff can connect securely to central resources without the inconvenience of going through a virtual private network and ICT can enforce centralized security policies such as encryption. “We can all sleep peacefully at night knowing that whatever network our users touch, they belong to us,” says Ian Arbuthnot, Director of IM&T at South East Coast Ambu-lance Trust. “We are all they can see and vice versa.”

Optimized Server and Data Center. Given the extensive amount of data that a health system encompasses, ICT staff must enable a streamlined delivery system that is highly secure and easy to manage. Compliance efforts must be tracked, and sensitive data must be protected through sophisticated identity-management tools.

At the same time, because health workers need uninterrupted access to systems, ICT ser-vices must be designed with availability, reliability, and business continuity in mind. To this end, ICT staff can take advantage of server virtualization technologies. Virtualization helps maintain data availability and—by utilizing server capacity to the fullest—it reduces storage, energy, and administration costs.

“We can all sleep peacefully at night knowing that whatever network our users touch, they belong to us. We are all they can see and vice versa.”

— Ian Arbuthnot, Director of IM&T at South East Coast Ambulance Trust


In the United States, Dartmouth-Hitchcock Medical Center (DHMC), an academic medical center in New Hampshire, is focusing on this aspect of the integrated infrastructure. The ICT staff began to look into virtualization three years ago because of limited space in its data center and rising electric costs. However, its original approach caused some server man-agement problems, along with unintended downtime, which interfered with the hospital’s patient services.

When the ICT staff learned about the Windows Server 2008 operating system and Hyper-V™ virtualization technology, it was immediately interested. “It was getting harder to manage our virtualized environment, so we were really excited about the management efficiencies we would get with System Center Virtual Machine Manager 2008,” says Robert McShinsky, Se-nior Systems Administrator at DHMC. “The Quick Migration feature and central Administrator Console would really simplify and speed routine server management.”

In addition to simplified server management, virtualization has enabled the ICT staff to provide higher application availability for patient-critical applications, such as the hospital’s scheduling application and operating room monitoring systems, and to create more stable backup processes. “With Hyper-V, we can move affected applications to new servers without users even knowing, completely eliminating downtime,” McShinsky says.

In all, DHMC expects to consolidate an additional 75 servers using virtualization, which will lead to a cost savings of more than $325,000 annually, he says. “These savings come from a per-server savings of $1,400 from lower maintenance costs; $1,600 from reductions in data center power, cooling, and space; and $1,300 from hardware savings.”

Health organizations can also optimize their infrastructure with cloud-based solutions. Ortho-pedic diagnostic, treatment, and rehabilitation center annatommie, in The Netherlands, is using the Microsoft Business Productivity Online Standard Suite from Microsoft Online Services for communication and collaboration. For a low per-user monthly subscription fee to Exchange Online, annatommie employees are able to send and receive email messages, book treatment rooms and equipment, and schedule meetings. Staff members in any of annatommie’s four of-fices can view all of these shared resources from the firm’s SharePoint Online site.

By integrating the appointment scheduler with the patient data system, annatommie enables staff to use electronic forms with automated workflows in the Microsoft Office InfoPath® information gathering program. Staff members can enter patient data electronically using SharePoint Online and automatically route forms to the appropriate people. Built-in security measures ensure that only authorized personnel can view patient files, which remain on-site in an annatommie database, although they are still accessible to employees through the cloud-based system.

Security and Compliance. Because ICT staff deals with sensitive health data, data security and compliance with industry or governmental regulations are crucial. An optimized infra-structure incorporates a clearly defined security policy, one that protects privacy and reduces vulnerability by incorporating highly granular security settings. For example, by delivering systems with access rights based on roles rather than individuals, ICT staff can more easily manage who gets access to certain data and control that access. At the same time, though, security cannot be a barrier to data access. When accessed via a holistic infrastructure

“It was getting harder to manage our virtualized environment, so we were really excited about the management efficiencies we would get with System Center Virtual Machine Manager 2008. The Quick Migration feature and central Administrator Console would really simplify and speed routine server management.” — Robert McShinsky, Senior

Systems Administrator at DHMC


through which the ICT staff can propagate appropriate security rules, data can be protected through centralized solutions rather than piecemeal solu-tions that may create vulnerabilities.

Identity management is particularly challenging in hospital environments that employ temporary interns, residents, and ICT staff. Sentillion proVision, part of the Microsoft acquisition and available only to healthcare provider organizations such as hospitals, helps ICT staff deliver centralized policies for creating, managing, suspending, or terminating network and applica-tion accounts in clinical and business applications. This capability enables ICT to ensure that caregivers have the access they need on the first day of their assignment and that those privileges are turned off when their tenure concludes. Using an automated system also helps ICT deliver audit reports for compliance purposes.

Microsoft offers other options for security, as well. Australia’s Tasmanian De-partment of Health and Human Services (DHHS) has paid particular atten-tion to security in its Microsoft® Office SharePoint® Server 2007 community portal. The DHHS implemented the portal to integrate information from diverse sources and to give clinicians secure access to state and local health policies and procedures, up-to-date staff lists, and professional resources. The information is tailored by role or location, so clinicians access only the information they need to do their jobs. Rights management policies also ensure that only those people who are authorized to view, edit, and publish documents can do so, thereby protecting sensitive information and mini-mizing risk.

Health Integration and Interoperability. When all of these solutions come together, the ultimate result is a manageable, cost-effective infrastructure that enables information sharing across the health ecosystem. By making information more fluid, ICT departments deliver a system in which health professionals, caseworkers, and others are interconnected, which enables them to work together to provide services more effectively with a single view of patient and citizen data.

And by delivering systems in which data extensibility is a main tenet, data can be updated once and propagated accordingly. This capability provides a

key benefit to public health and social services agencies, providers, and patients and citi-zens: the assurance that the data they are accessing is timely and accurate. At the same time, system integration and interoperability reduce costs because they enable new and existing technologies to coexist and because there are fewer servers to deliver and manage. The Hospital District of Helsinki and Uusimaa (HUS) is Finland’s largest health organization, with more than 445,000 people using its services annually. HUS recently upgraded its ICT environ-ment from a host of disparate systems to Microsoft® BizTalk® Server, using Microsoft BizTalk Accelerator for HL7, so that its hospitals can collaborate efficiently in an environment that integrates different critical applications.

Connected Health Platform Solution AcceleratorsThe aim of these solution accelerators is to help organizations more quickly improve efficiencies.


The Microsoft Health Common User Inter-face—Design Guidance and Controls for Healthcare Application Developers

Health Connection Engine

Cross-Enterprise Docu-ment Sharing XDS.b

Health Collaboration Fundamentals

Managing Meetings for Health Organizations

Using Scorecards to Improve Performance Management in Healthcare

Policies and Procedures

Electronic Forms Resource Kit

Template Gallery

Promotes improved patient safety in clinical applications by providing user in-terface designers, application developers, and patient safety experts with guidelines, controls, and showcase demonstrators.

Facilitates interoperability among multiple systems by abstracting the interfaces used to connect them and by providing a rich and extensible adapter framework. Based on the IHE XDS.b integration profile, which provides a standards-based interoperable approach for managing document sharing between any health enterprise, XDS.b improves patient safety and staff efficiency by allowing timely ac-cess to patient data at the point of care.

Provides on-demand collaborative work-spaces, discussion forums, and a people directory.

Provides a shared workspace where meet-ing attendees or committee members can share agendas, papers, presentations, and actions.

Acts as a template for configuring a management dashboard to track organi-zational metrics.

Assists health organizations that find it difficult to create, maintain, publish, and easily access policy and guideline information.

Enables the creation of electronic forms by providing a User Information Web Service and set of template parts, sample forms, and supporting tools.

Assists in creating a Template Gallery site, as either part of an intranet portal or a stand-alone Web site. This site will enable users to centrally publish, discover, rate, and request electronic assets such as document templates, Microsoft® Office Groove® templates, electronic forms, and spreadsheets.

Health Solution DescriptionAccelerator


“Communication has never been better,” says Mikko Rotonen, Development Director for HUS ICT. “The efficiency of how we deal with patients has improved remarkably, and the scal-ability of the solution means we can continue to grow for the foreseeable future—and this at a low cost.” HUS staff can now collaborate faster and easier among departments, hospitals, and external health services, which results in thorough patient care. It also enjoys 28 percent higher system throughput and potentially even more scalability.

Accelerating the EffortAn example of the head start that the Microsoft CHP guidance, tools, and solution accelerators can provide is Melbourne-based Fred IT Group, Aus-tralia’s largest ICT solution provider to the pharmaceutical industry. Fred IT contracted with a Microsoft partner to develop an electronic prescription solution, called eRx Script Exchange. Using the Microsoft CHP Health Con-nection Engine solution accelerator, the partner was able to deliver the solu-tion in just six months (see Figure 7, “Connected Health Platform Solution Accelerators,” on page 13).

The eRx system sends prescriptions through a secure gateway for retrieval by a patient’s pharmacy of choice, no matter where in Australia the patient or the pharmacy is located. It does not interfere with the workflows currently used by clinicians and pharmacists; rather, it augments the existing paper prescription system to be more efficient. With paper-based scripts, there was a lack of communication among general practitioners (GPs), not to mention transcription errors—a major healthcare cost in Australia. GPs and special-ists were also unable to track whether prescriptions were filled. The eRx Script Exchange has reduced errors and improved patient care and safety. “With eRx, the prescriber and pharmacist can be assured that what the GP or specialist prescribes is presented electronically to the dispense system,” says David Freemantle, Project Director for the eRx Script Exchange.

The Benefits of an Integrated, Optimized InfrastructureThe idea of implementing or managing all of these offerings—whether through traditional or cloud-based computing models—may seem daunting. But the fact is, they are all inter-related, as evidenced by the commonality of many of the products within the Microsoft CHP to solve the relevant issues. As a result, implementing any one of them makes delivering the next one less complicated.

More importantly, the top benefits of an integrated infrastructure strongly correlate to issues that medical practitioners expect health ICT executives to solve (see Figure 8, “Resolving Issues,” at left). One of the more daunting issues in this regard is the ability to consolidate information from multiple sources in a way that offers consistent access for a variety of users without burdening ICT with an untenable integration challenge. In those situations, cloud computing can bring unprecedented capabilities for information delivery at reasonable cost with appropriate security.

Resolving IssuesThe benefits of an integrated infrastructure closely align to top health industry issues.


Health Industry Issue Benefits of an Integrated Infrastructure

Automating ICT administrative activities reduces labor costs both within hospitals and at social services agencies.

Easy-to-use client devices help citizens access and update health information.

Role-based access protects patients and citizens while aiding compliance for both health and governmental organizations.

Virtualization technology im-proves system reliability.

An integrated infrastructure enables data sharing across systems.

The use of integrated collabora-tion technologies, such as unified communications, aids diagnosis and treatment.

An integrated infrastructure makes it simpler to add new capabilities.

Advocates and critics alike are calling for cost savings across the care continuum.

Public health services need to track citizen health beyond traditional care facilities.

The industry must protect sen-sitive data while also accessing data to discover trends.

Medical practitioners are concerned with the availability of electronic records.

Practitioners need insight into patient care, from the hospital to the clinic to the patient’s home.

To better utilize expensive spe-cialists, the industry requires remote-care options.

The industry needs to accom-modate future advances in technology.


Ultimately, because its boundaries span further than any single entity, the health industry must focus its endeavors beyond specific applications and data toward best practices and a flexible underlying platform. That is the goal of the best practices within the Microsoft Connected Health Framework and also of the applications and services within the Microsoft Connected Health Platform. The CHP, with its CHF foundation, creates a sustainable, cost-effective environment that enables easy access to secure and accurate health data across the entire health ecosystem, efficient and flexible use of technology resources, and better insights into ways to continually improve public health outcomes and patient care and to empower patients and citizens to proactively manage their own care.

The goals, of course, are improved outcomes in health and social services, says Accenture Se-nior Manager Andrew Truscott, who has focused on health ICT, including security, for the last 10 years. Truscott has also worked in ICT at the NHS. “We’ll understand so much more about welfare, social care, morbidity, and other issues,” he says. The more data you have, Truscott believes, the more information you can analyze. “You can’t do that with data silos. The payoff will come when we have tools that break down the silos.”

Just as humans will always develop ailments, medical technology will always create capabili-ties to address those ailments. And those capabilities will undoubtedly be embedded not only in applications but in devices that will need to be both easy to use and accessible across a network. This approach reflects perhaps the most important aspect of an integrated infra-structure: a foundation on which the health ecosystem can accommodate the changes the industry is sure to face—rapidly, effectively, securely, and reliably.

For More Informationannatommiehttp://www.microsoft.com/casestudies/Case_Study_Detail.aspx?CaseStudyID=4000003679

Health ICT Resource Center http://www.microsoft.com/healthict

Microsoft Core IO Assessmenthttp://www.microsoft.com/infrastructure/about/gettingstarted.mspx

Dartmouth-Hitchcock Medical Centerhttp://www.microsoft.com/casestudies/Case_Study_Detail.aspx?CaseStudyID=4000002484

eRx Script Exchangehttp://www.microsoft.com/casestudies/Case_Study_Detail.aspx?casestudyid=4000005221

Hospital District of Helsinki and Uusimaahttp://www.microsoft.com/casestudies/Case_Study_Detail.aspx?casestudyid=4000002764

Saiseikai Kumamoto Hospitalhttp://www.microsoft.com/casestudies/Case_Study_Detail.aspx?casestudyid=4000003702

Because its boundaries span further than any single entity, the health industry must focus its endeavors beyond specific applications and data toward best practices and a flexible underlying platform.


South East Coast Ambulance Trusthttp://www.microsoft.com/uk/nhs/content/articles/windows-7-makes-data-more-secure-at-south-east-coast-ambulance.aspx

Tasmanian Department of Health and Human Serviceshttp://www.microsoft.com/casestudies/Case_Study_Detail.aspx?casestudyid=4000000683

Tennessee Department of Human Serviceshttp://www.microsoft.com/casestudies/Case_Study_Detail.aspx?CaseStudyID=4000001330

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